Wiltse入路结合改良TLIF治疗中重度腰椎滑脱症的临床疗效  

Clinical efficacy of Wiltse approach combined with modified TILF technique in the treatment of moderate to severe lumbar spondylolisthesis

作　　者：蒲俊刚 王腾羽 王钟 范伟力 刘鹏 赵建华 PU Jun-gang;WANG Teng-yu;WANG Zhong;FAN Wei-li;LIU Peng;ZHAO Jian-hua(Department of Spinal Surgery,Characteristic Medical Center of Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学特色医学中心脊柱外科,重庆400042

出　　处：《局解手术学杂志》2020年第8期630-635,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金项目(81902257)。

摘　　要：目的探讨经Wiltse入路结合改良经椎间孔腰椎体间融合术(TLIF)治疗中重度腰椎滑脱症的临床疗效。方法回顾性分析2014年1月至2017年1月我科收治并获得随访的51例中重度腰椎滑脱症患者的病历资料,均采用Wiltse入路结合改良TLIF治疗。统计患者手术时间、术中出血量及术后并发症情况,影像学观察椎间隙高度、滑脱角、滑脱率及融合率,采用腰痛和下肢痛视觉疼痛模拟量表(VAS)及Oswestry功能障碍指数(ODI)评定临床疗效。结果患者手术时间99~202 min,平均(115.0±16.7) min;术中出血量101~320 m L,平均(170.8±63.6) m L。随访13~36个月,平均(21.6±5.7)个月。共3例患者出现并发症,其中1例硬脊膜撕裂,2例术后出现L5神经根麻痹症状。患者腰痛VAS评分、下肢痛VAS评分及ODI分别由术前的(6.7±1.8)分、(6.8±2.0)分、(61.7±11.6)%下降至末次随访时的(2.2±1.0)分、(1.3±1.2)分、(18.5±5.6)%,椎间隙高度由术前的(5.17±1.72) mm提高至末次随访时的(10.23±1.01) mm,滑脱角和滑脱率分别从术前的(7.03±1.82)°和(49.8±6.7)%下降至末次随访时的(1.23±0.68)°和(10.1±3.8)%,差异均有极显著性统计学意义(P <0.01)。术后6个月49例患者获得坚强融合,2例可能融合,融合率为96.1%。结论经Wiltse入路结合改良TLIF对腰椎后部肌肉及后方韧带复合体破坏小,是一种治疗中重度腰椎滑脱症的理想微创手术方法。Objective To explore the curative effect of Wiltse approach combined with modified transforaminal lumbar interbody fusion( TLIF) technique in the treatment of moderate to severe lumbar spondylolisthesis. Methods A retrospective analysis was performed on 51 cases of moderate and severe lumbar spondylolisthesis treated by Wiltse approach combined with modified TLIF surgery in our department from January 2014 to January 2017. Time of the surgical operation,intraoperative blood loss and complications of patients were recorded. The height of intervertebral space,the slipping angle,the slippage rate and fusion rate were measured by observing the imaging data. Visual analogue scale( VAS) scores of low back pain and lower limb pain and Oswestry disability index( ODI) were collected. Results The operation time was 99 to 202 minutes,( 115. 0 ± 16. 7) minutes averagely;the amount of bleeding was 101 to 320 mL,( 170. 8 ± 63. 6) mL averagely. The follow-up time was 13 to 36 months,( 21. 6 ± 5. 7) months averagely. A total of 3 patients developed complications,including1 case of dural tear and 2 cases of postoperative L5 nerve root paralysis. The VAS score of low back pain and lower limb pain and ODI decreased from( 6. 7 ± 1. 8) points,( 6. 8 ± 2. 0) points and( 61. 7 ± 11. 6) % before operation to( 2. 2 ± 1. 0) points,( 1. 3 ± 1. 2) points and( 18. 5 ±5. 6) % at the last follow-up;the intervertebral disc height increased from( 5. 17 ±1. 72) mm before operation to( 10. 23 ±1. 01) mm at the last follow-up;the mean slipping angle and slippage rate decreased from( 7. 03 ± 1. 82) ° and( 49. 8 ± 6. 7) % before operation to( 1. 23 ± 0. 68) ° and( 10. 1 ± 3. 8) % at the last follow-up respectively;and all the differences were statistically significant( P < 0. 01).Strong fusion was achieved in 49 patients,and possible fusion was achieved in 2 patients,and the fusion rate was 96. 1% at 6 months after surgery. Conclusion Wiltse approach combined with modified TILF technique has little damage to the posterior lumbar musc

关 键 词：Wiltse入路 经椎间孔腰椎体间融合术 腰椎滑脱症 后路复位 神经根损伤 

分 类 号：R687.3[医药卫生—骨科学]